Advertisement
Health Outcomes Research| Volume 80, ISSUE 6, P1247-1251, December 2012

Urinary Diversion in Patients With Spinal Cord Injury in the United States

      Objective

      To describe the patterns in the use of bladder augmentation and urinary diversion to manage urologic sequelae among patients with spinal cord injury in the United States.

      Materials and Methods

      Discharge estimates were derived from the Nationwide Inpatient Sample. All patients underwent bladder augmentation or ileal conduit diversion from 1998 to 2005 and had a diagnosis of spinal cord injury.

      Results

      Ileal loop diversion was performed in an estimated 1919 patients and bladder augmentation in 1132 patients with spinal cord injury from 1998 to 2005. Patients undergoing urinary diversion tended to be older (mean age 46 vs 34 years; P <.001) and to have Medicare as the primary payer (55.0% vs 30.8%; P <.001). Patients who underwent urinary diversion appeared to use more healthcare resources, with a longer length of stay (15 vs 9 days), higher hospital charges ($58,626 vs $37,222), and a greater use of home healthcare services after discharge (all P <.001). Patients at teaching institutions were more likely to undergo bladder augmentation (42%) than those at nonteaching institutions (23%; P <.001).

      Conclusion

      Bladder augmentation is used in approximately one-third of cases to manage the urologic complications of spinal cord injury. These patients likely constitute a clinically distinct population that uses fewer healthcare resources. The lower augmentation rates at nonteaching institutions may indicate an opportunity for quality improvement.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • National Spinal Cord Injury Statistical Center
        Spinal Cord Injury Facts and Figures at a Glance. University of Alabama at Birmingham, Birmingham, AL2011
        • Stoffel J.T.
        • McGuire E.J.
        Treating the adult neurogenic bladder. Preface.
        Urol Clin North Am. 2010; 37: xi-xii
        • McGuire E.J.
        • Woodside J.R.
        • Borden T.A.
        • et al.
        Prognostic value of urodynamic testing in myelodysplastic patients.
        J Urol. 1981; 126: 205-209
        • Geisler W.O.
        • Jousse A.T.
        • Wynne-Jones M.
        • et al.
        Survival in traumatic spinal cord injury.
        Paraplegia. 1983; 21: 364-373
        • Webb D.R.
        • Fitzpatrick J.M.
        • O’Flynn J.D.
        A 15-year follow-up of 406 consecutive spinal cord injuries.
        Br J Urol. 1984; 56: 614-617
        • Jeong S.J.
        • Cho S.Y.
        • Oh S.J.
        Spinal cord/brain injury and the neurogenic bladder.
        Urol Clin North Am. 2010; 37: 537-546
        • Schoenberg H.W.
        • Shah J.P.
        • Kyker J.
        • et al.
        Changing attitudes toward urinary dysfunction in myelodysplasia.
        J Urol. 1977; 117: 501-504
        • Linder A.
        • Leach G.E.
        • Raz S.
        Augmentation cystoplasty in the treatment of neurogenic bladder dysfunction.
        J Urol. 1983; 129: 491-493
        • Madersbacher S.
        • Schmidt J.
        • Eberle J.M.
        • et al.
        Long-term outcome of ileal conduit diversion.
        J Urol. 2003; 169: 985-990
      1. Agency for Healthcare Research and Quality. Introduction to the HCUP Nationwide Inpatient Sample (NIS), 2005. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2005.jsp. Accessed December 15, 2011.

        • Quek M.L.
        • Ginsberg D.A.
        Long-term urodynamics followup of bladder augmentation for neurogenic bladder.
        J Urol. 2003; 169: 195-198
        • McInerney P.D.
        • DeSouza N.
        • Thomas P.J.
        • et al.
        The role of urodynamic studies in the evaluation of patients with augmentation cystoplasties.
        Br J Urol. 1995; 76: 475-478
        • Khoury J.M.
        • Timmons S.L.
        • Corbel L.
        • et al.
        Complications of enterocystoplasty.
        Urology. 1992; 40: 9-14
        • Herschorn S.
        • Hewitt R.J.
        Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder.
        Urology. 1998; 52: 672-678
        • Scales Jr., C.D.
        • Wiener J.S.
        Evaluating outcomes of enterocystoplasty in patients with spina bifida: a review of the literature.
        J Urol. 2008; 180: 2323-2329
        • Chartier-Kastler E.J.
        • Mozer P.
        • Denys P.
        • et al.
        Neurogenic bladder management and cutaneous non-continent ileal conduit.
        Spinal Cord. 2002; 40: 443-448
        • Guillotreau J.
        • Castel-Lacanal E.
        • Roumiguie M.
        • et al.
        Prospective study of the impact on quality of life of cystectomy with ileal conduit urinary diversion for neurogenic bladder dysfunction.
        Neurourol Urodyn. 2011; 30: 1503-1506
        • Wiener J.S.
        • Antonelli J.
        • Shea A.M.
        • et al.
        Bladder augmentation versus urinary diversion in patients with spina bifida in the United States.
        J Urol. 2011; 186: 161-165

      Linked Article

      • Editorial Comment
        UrologyVol. 80Issue 6
        • Preview
          It is not uncommon for urologists to encounter patients with spinal cord injury whose neurogenic bladder dysfunction has not responded to “conservative” management with medications and catheterization. This is a very heterogeneous group of patients with variable degrees of functional impairment (eg, paraplegia, quadriplegia), urologic abnormalities (eg, detrusor overactivity, diminished bladder compliance, hydronephrosis, renal damage, urethral dysfunction), and comorbidities (eg, obesity, previous abdominal surgeries, decubitus ulcers, neurogenic bowel dysfunction).
        • Full-Text
        • PDF